Lawmakers begin looking for ways to fund Maine’s share of Medicaid expansion


AUGUSTA — Surpluses expected in the next two-year budget cycle could provide a starting point for funding the state’s share of Medicaid expansion, but it isn’t clear whether lawmakers would agree to use that money, or whether Gov. Paul LePage would veto such a move.

But the state’s share of expanding the health insurance program for low-income residents is an estimated $60 million, and the budget surplus is expected to be only about $12.5 million at the end of the coming two-year budget cycle in June 2019. Lawmakers will get a revised budget forecast in April.

The Legislature’s appropriations committee met Wednesday to start work on an official estimate of the costs and savings of Medicaid expansion. So far, lawmakers have offered no ideas about how to pay for it. The expansion funding battle is likely to consume much of the legislative session starting in January.

On Monday, LePage reiterated his opposition to expansion and in a letter to legislative leaders said they would have to find a way to pay the state’s share without raising taxes, cutting programs for disabled and elderly residents, or raiding the budget stabilization, or Rainy Day, fund – which LePage wants to increase to $300 million to lower the state’s borrowing costs. LePage also said he expects lawmakers to eliminate waiting lists for services for disabled and elderly residents before expanding MaineCare, the state’s Medicaid program.

Democrats say the state is obligated to expand MaineCare after it received the support of 59 percent of state voters in a November referendum. After the law takes effect on Jan. 3, the Department of Health and Health Services must apply to expand MaineCare by April 3 and expand the program by July 2, analysts say.

Expansion would provide coverage to about 80,000 low-income residents – those earning less than 138 percent of the federal poverty level, or about $17,000 a year for a single adult and $22,412 for a two-person household.


LePage, a staunch opponent of Medicaid expansion, is unlikely to cooperate by quickly providing data needed to figure out how to fund the state’s share.

The governor has said lawmakers must put questions in writing and that experts from both the Maine Revenue Service, which collects taxes, and the Department of Health and Human Services, which oversees Medicaid, will be barred from appearing before the budget-writing appropriations committee.

During its three-hour meeting Wednesday, the committee reviewed the state’s revenue forecast and the work of its non-partisan Office of Program and Fiscal Review, which has crunched the numbers on health care expansion costs at least five different times when lawmakers considered earlier Medicaid expansion bills. The state’s share of the expansion cost would be an estimated $55 million a year for the fiscal year beginning July 1, and would expand to an estimated $60 million a year by 2021. But that would draw down about $525 million in federal matching funds.

Appropriations committee members focused on how much expansion would cost the state and when it would need the money, and worked on questions for DHHS.

At the top of that list is why DHHS has not provided an accounting for any savings in other state health programs, such as mental health and addiction services for low income residents, that would be recouped if MaineCare is expanded. According to Luke Lazure, an analyst with the fiscal review office, the state spends about $35 million a year on those programs.

“I would like to understand, I would love to see the same kind of detail from the department on what their estimate of costs are, the same kind of detail that (Lazure) just gave us here,” said Rep. Drew Gattine, D-Westbrook, the House chairman of the Appropriations Committee. He said he hoped DHHS officials were at least listening to the meeting Wednesday. “Because I think the goal here is to get to the right number.”

Gattine and other lawmakers said they would put questions in writing, but that the process should be more open-ended because the answer to one question often generates another.

Gattine said he wants to get to a implementation timeline and a plan for rolling out expansion, but some Republicans on the committee clearly backed LePage’s demand that a way to pay for expansion be found first. Neither committee Republicans nor LePage have offered suggestions on how to pay for it.

Democrats noted that they are prohibited from estimating how much the state might save in costs to other programs because of expansion, or how much additional income tax revenue might be generated by the estimated 6,000 health care jobs it is expected to create.

Expansion would also create at least 103 new jobs in DHHS and at least one lawmaker, state Rep. John Martin, D-Eagle Lake, suggested Wednesday some of those jobs should be located in rural Maine and outside of Augusta.

Gattine said the projected two-year revenue surplus of $12.5 million may be a starting point for expansion-funding talks, but that dozens of other proposals will compete for that funding.

Maine State House is the state capitol of the State of Maine in Augusta, Maine, USA.

  • FrankE

    How are they able to continue this farce? Trying to downplay the ACA as on it’s last leg, not worth saving. Yet in the very next story of this publication, thousands of new policies are written just this year. That isn’t a good indication that something is dying or on it’s way out. Paul LePage can always find cash for his idiotic ideas when he needs to, yet insuring thousands of poor Mainers isn’t among his priorities. I can’t wait until we have a Governor willing to work for the people of Maine not against them…………………

  • Thomas Knight

    LePage will not permit his administration officials to participate in the proceedings, nor will he. This is Maine’s government, not his personal clique. We need to get our government back from this tyrant so it can once again serve the people that it is intended to.

  • mikemattmic

    Why don’t we stop importing more and more poor people into Maine. Maine needs jobs, corporate expansion, lower taxes, and people able to support themselves. Yet we march daily into the heavenly arms of ” diversity” without regard to planning or cost. Medicare was last expanded “to help the poor” under the great governor Angus King. He passed a 750 million dollar deficit on to John Baldacci who kicked the ball on to Paul LePage. LePage is opposed Medicaid expansion because Maine can’t afford it. It took him two terms to deal with the last King/Baldacci deficit. When will Maine people learn that the government is not here to serve or save them. Only good jobs and hard work will do that. Please…no more diversity until we can assimilate and pay for the diversity we have already been blessed with.

    • FrankE

      What planet were you born on? LePage is against Medicaid expansion for one reason, politics. He’s been nothing but a lump on a log since becoming the so called Governor. What this state truly needs is an informed Governor willing to work with others, not a Republican. His banning certain state agencies from attending certain meetings isn’t normal activity for any governor. I’m disabled, I’m also a tax payer. I expect government to help me in any way possible thats why I paid my taxes for so long. Just like on the side of police cars, Government is to serve and protect, not put everything off until someone with an once of intelligence somehow gets elected.

  • Thomas Knight

    If “the government is not here to serve us,” let’s get rid of it!

  • Melinda

    FrankE, seems to me lepage always has money for what he wants because it was stolen from programs it was intended for. Look at the way he and mayhew “misappropriated” designated funds from one dhs program then paid it back. One very important program that has funding appropriated for it in the budget every year is the Public Health Nursing Program but that program has been virtually dismantled due to the ineptitude of people like mayhew and peavey who, thankfully, is no longer the director of Mecdc. The funding was there but no nurses were being hired to replace those who retired or move on to other positions. What happened to that funding? What other programs has lepage stripped of their funding so he can pocket it? One huge problem with dhs is that they put people in charge of things they are not qualified to oversee, like peavey being director of the cdc and has absolutely no medical background. dhs likes to keep the thieves, liars and morally bankrupt while forcing the good workers out, that’s why zukas is still there after costing taxpayers over $500,000 on two lawsuits, one of which was inappropriate document shredding. She should have been fired like she was from a previous position she held in state government. lepage came up with money for huge pay increases for all the commissioners because, and the union went along with this, he denied employees a 3% pay increase two years ago, only gave them 1%. This year the union gave back the first half of this fiscal years pay increase. The employees voted for a 6% increase which they deserve but aren’t receiving it for the first half of this fiscal year because the union gave it back to lepage. In essence those employees are only getting a 3% pay increase not the 6% they voted for. Thank you MSEA!!! Your support of the employees is appreciated. NOT. So, that was a long way of saying how lepage gets his funding for what he wants.